what if...

[mellowtigger]

What would happen if diagnosis was entirely separated from prescription?  So you'd go to a doctor to diagnose a problem and get a document stating your condition and/or recorded symptom.  (Like an optometrist today records measurements of your eye performance on visual tests.)  Then you'd take your diagnosis somewhere else to get treatment.  Perhaps treatment could be an expansion of the pharmacist role, or it could be a whole new role in medicine.

• Is there a way to legalize self-prescribing of some medications?  Which medications?
• Is there a way to reduce legal burdens by spreading medical expertise amongst other working classes besides "doctors"?  Like perhaps the midwife can still do today?
• Is there a way to remove the profit motive from medical care?  The obvious conflict of interest is that doctors/corporations get more money if they keep you only healthy enough to come back for more consultations.
• Is there a way to reward doctors for fast and accurate diagnoses, regardless of patient outcome?
• Given a diagnosis, is there a way to increase competition for treatment options and reduce costs?

Perhaps treatment regimen provides the immediate feedback that a doctor needs to reinforce learning that a diagnosis was accurate.  If the two activities were split, maybe doctors would be less accurate instead of more accurate with diagnoses?

I'm just wondering out loud.

Comments

[otterlover01.livejournal.com]

BTW, I've heard there's no private medical practice in Canada. If it is true, does that work out better? :o/

[mellowtigger]

I've heard that they have socialized medicine, yes, but I don't know any details of it.

When I was a student at Texas A&M University, I would sometimes see people going to the clinic when they really weren't as ill as other people. They tried to get the nurses to do triage, but there were just too many students for too few doctors. It was good to have "free" medical examination available, but it was too freely available so some people used it more than really necessary.

[furr-a-bruin.livejournal.com]

Considering that pharmacists spend 4 years studying a topic that doctors (at best) spend 6 months on - I've always thought that pharmacists should take the lead in prescribing medications. Especially so considering how complex drug therapy can get for people with multiple health problems, what with side effects, drug interactions, prescriptions from multiple physicians and specialists and so on. Particularly in such cases, I think the ideal would be a consultation between a physician and a pharmacist.

[mellowtigger]

A good idea. As as we learn more about drug interactions (and food/drug interactions), the pharmacist will have even more to learn. I'd rather that this phase of medicine have a specialist on it rather than relying on a diagnosing doctor to keep up with all of these things.

An investment in knowledge engineering

[beartech420.livejournal.com]

You know both the diagnosis and the prescription could be automated into an A.I. expert system. Knowledge engineers have been working on diagnosis programs for years. If a national health program made this software development a priority the price of it would become very inexpensive. You could have P.A.s use these programs and at the same time supervise the medical tests. If the software was like 70 percent certain the patient could referred to a human expert for a better percentage.
BestRegards,
Pete

Re: An investment in knowledge engineering

[mellowtigger]

I really like that idea, except for Idiocracy...
http://uk.youtube.com/watch?v=js0sy-Mq58U

Perhaps one could make the deal that medical school would be entirely paid, so long as the doctor's later practice could be completely recorded to aid in improving the expert knowledge system. There just needs to be a way to keep human skill involved in constantly improving the system rather than relying solely on the previously accumulated knowledge.

Re: An investment in knowledge engineering

[mellowtigger]

Maybe that could be a condition for self-prescribing too. People have to go through training in how to enter their medical experience into a database so that their self-directed exploration into medicine can be used to expand the knowledgebase. Basically, allowing people to experiment upon themselves as they see fit, so long as their activity has the potential to help the rest of society too.

Re: An investment in knowledge engineering

[beartech420.livejournal.com]

Ideally the expert system could observe and learn from a group of real good doctors. This could move along faster when the holy grail of engineering the brain computer interface is designed. Make it a lot easier and faster for A.I. programs to learn about everything. Get us a step closer to the "Singularity".
www.singinst.org/overview/whatisthesingularity

[khrysso.livejournal.com]

I love being able to be witness to good thinking, which all this definitely is.

I'd be concerned that if doctors were removed any distance from consistent relationships with patients, that insurance companies would gain even more power to override doctors' and pharmacists' recommendations.

My companion was just turned down on appeal from her doctor because Anthem didn't want to pay for her Celebrex prescription until she had jumped through four months' worth of hoops...

[mellowtigger]

I like to think (wishful thinking, of course) that separating them would mean that diagnosis would be free of such intense scrutiny by insurance companies. They would be trying to reduce expensive testing, I'm sure, but a "deadly" diagnosis would mean no more to them than a "mild" diagnosis, as long as it was accurate for the patient.

The prescribing/therapeutic doctor would be responsible for treatment regimen, which I think is where most of the cost cutting (claims denial) happens these days. Maybe?